Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements.
delivery
disease-modifying treatment
intrapartum
multiple sclerosis
postpartum
pregnancy
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
accepted:
09
08
2023
medline:
25
9
2023
pubmed:
25
9
2023
entrez:
25
9
2023
Statut:
epublish
Résumé
Family planning is essential for establishing Multiple Sclerosis (MS) prognosis, treatment decision, and disease monitoring. We aimed to generate an expert consensus addressing recommendations for family planning in MS patients of childbearing age. Initially, a committee comprising seven neurologists, experts in the MS field, identified the topics to be addressed. Then, the committee elaborated on different evidence-based preliminary statements. Next, using the Delphi methodology, a panel of neurologists manifested their level of agreement on the different statements using a Likert-type scale. Consensus was reached when ⩾70% of respondents expressed an agreement or disagreement using a five-point scale. Consensus was achieved on 47 out of 63 recommendations after three rounds of evaluations. The panel considered it essential to address family planning in all patients of childbearing age. There was also consensus that treatment should not be delayed due to the patient's desire for pregnancy. Additionally, in highly active patients, planning the pregnancy in the medium to long term using depletory drugs such as cladribine or alemtuzumab might represent a useful strategy. However, risks of adverse effects on the fetus due to drug-associated secondary autoimmunity should be addressed when alemtuzumab is considered. Moreover, the maintenance of natalizumab during pregnancy in very active patients reached expert consensus. Also, the panel supported the use of certain disease-modifying treatment (DMT) during lactation in selected cases. Our results identified specific areas of pregnancy planning in MS patients, where different treatment strategies might be considered to facilitate a safe and successful pregnancy while maintaining clinical and radiological stability.
Identifiants
pubmed: 37746391
doi: 10.7759/cureus.44056
pmc: PMC10517726
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e44056Informations de copyright
Copyright © 2023, Oreja-Guevara et al.
Déclaration de conflit d'intérêts
The authors have declared financial relationships, which are detailed in the next section.
Références
Neurol Ther. 2018 Dec;7(2):207-232
pubmed: 30167914
Acta Med Port. 2020 Sep 1;33(9):611-621
pubmed: 32893778
BJOG. 2011 Jun;118(7):790-7
pubmed: 21401856
Rev Neurol (Paris). 2021 Mar;177(3):180-194
pubmed: 32736812
Mult Scler Int. 2016;2016:1034912
pubmed: 28078140
Pharmacoepidemiol Drug Saf. 2019 Apr;28(4):556-560
pubmed: 30834654
Ther Adv Neurol Disord. 2020 Jun 24;13:1756286420935019
pubmed: 32636933
Curr Treat Options Neurol. 2021;23(4):11
pubmed: 33814892
Mult Scler Relat Disord. 2019 Aug;33:153-157
pubmed: 31202154
Brain. 2004 Jun;127(Pt 6):1353-60
pubmed: 15130950
Expert Opin Drug Saf. 2017 May;16(5):523-534
pubmed: 28333552
Neurol Ther. 2023 Apr;12(2):427-439
pubmed: 36746871
Med Clin North Am. 2021 Mar;105(2):341-353
pubmed: 33589107
Neurology. 2018 Mar 6;90(10):e840-e846
pubmed: 29429970
Mult Scler. 2020 May;26(6):642-643
pubmed: 32081082
Neurology. 2021 Feb 2;96(5):e783-e797
pubmed: 33372028
Mult Scler. 2018 Jun;24(7):991-994
pubmed: 28920764
Lancet Neurol. 2021 Aug;20(8):653-670
pubmed: 34139157
Neurotherapeutics. 2017 Oct;14(4):974-984
pubmed: 28766273
Continuum (Minneap Minn). 2019 Jun;25(3):773-792
pubmed: 31162316
Biomedicines. 2019 Apr 19;7(2):
pubmed: 31010259
Cochrane Database Syst Rev. 2016 Mar 22;3:CD009882
pubmed: 27003123
Med J Aust. 2019 Sep;211(5):230-236
pubmed: 30919466
Neurol Res Pract. 2019 Feb 28;1:5
pubmed: 33324871
Neurol Ther. 2019 Dec;8(2):241-250
pubmed: 31677060
Eur Neurol. 2021;84(2):71-84
pubmed: 33744881
Clin Rheumatol. 2021 Oct;40(10):3875-3882
pubmed: 33759082
N Engl J Med. 2018 Jan 11;378(2):169-180
pubmed: 29320652
Mult Scler J Exp Transl Clin. 2021 Mar 19;7(1):20552173211001571
pubmed: 33796332
Mult Scler Relat Disord. 2020 Aug;43:102147
pubmed: 32442883
Neurology. 2022 Aug 11;:
pubmed: 35953288
Pract Neurol. 2019 Apr;19(2):106-114
pubmed: 30612100
N Engl J Med. 1998 Jul 30;339(5):285-91
pubmed: 9682040
CNS Drugs. 2021 Apr;35(4):385-402
pubmed: 33797705